有越来越多的证据表明，维生素D具有广泛的组织效应。除了骨质疏松症，维生素D缺乏还与心血管疾病、糖尿病、癌症、感染和神经退行性疾病有关联。然而，维生素D补充对非骨骼结果的影响需要澄清，特别是在绝经后妇女中。这份声明根据观察和干预研究的证据，提供了维生素D在绝经后妇女健康中的作用的概述。文献综述和专家意见的共识。维生素D状态是通过测量血清25-羟基维生素D水平来确定的。浓度<20 ng/ml (<50 nmol/l)和<10 ng/ml (<25 nmol/l)被认为是维生素D缺乏和严重缺乏的标准。观察数据表明，维生素D缺乏与绝经后妇女的不良健康结果相关，尽管它们不能建立因果关系。关于维生素D补充的随机对照试验的证据不稳定，因为许多研究没有考虑人们是否在基线时存在缺乏。此外，群体研究、维生素D剂量、钙共同管理和干预持续时间方面存在高异质性。关于骨骼健康问题，维生素D缺乏与低骨量和骨折风险增加相关。在使用维生素D维持剂量800-2000 IU / day (20-50 μg / day)补充高周或高日剂量补充之后，只有与钙（1000-1200 mg/day）共同管理，才有可能在老年人群和严重维生素D缺乏人群中受益。关于心血管疾病问题，维生素D缺乏与心血管风险因素的增加有关，主要是代谢综合征、2型糖尿病和脂质代谢异常。维生素D缺乏，尤其是其严重形式，与心血管事件（冠心病、中风、死亡率）的风险增加有关，独立于传统风险因素。维生素D补充可能对脂质代谢和葡萄糖平衡有轻微的有益影响，特别是对于肥胖者或那些≥60岁的高剂量（≥2000 IU/day or ≥50 μg/day）。但它对心血管事件的发生率没有影响。关于癌症问题，维生素D缺乏与多种癌症的发生率和死亡率增加有关，如结肠直肠癌、肺癌和乳腺癌。然而，其他类型的妇科癌症的数据不一致。维生素D补充对癌症发生率没有影响，尽管观察到癌症相关死亡率略微降低。关于感染问题，维生素D缺乏已与急性呼吸道感染，包括2019冠状病毒病（COVID-19）相关。维生素D补充可能降低急性呼吸道感染的风险和COVID-19的严重程度（不是感染的风险）。关于绝经症状问题，维生素D缺乏可能对某些方面产生负面影响，如睡眠障碍、抑郁、性功能和关节疼痛。然而，维生素D补充对这些没有影响，除了阴道萎缩，需要相对较高的剂量，即每周40,000-60,000 IU（1000-1500 IU/week）口服或每天1000 IU（25 μg）阴道栓剂。 版权所有©2022 Elsevier B.V.。

There is increasing evidence that vitamin D has widespread tissue effects. In addition to osteoporosis, vitamin D deficiency has been associated with cardiovascular disease, diabetes, cancer, infections and neurodegenerative disease. However, the effect of vitamin D supplementation on non-skeletal outcomes requires clarification, especially in postmenopausal women.This position statement provides an evidence-based overview of the role of vitamin D in the health of postmenopausal women based on observational and interventional studies.Literature review and consensus of expert opinion.Vitamin D status is determined by measuring serum 25-hydroxyvitamin D levels. Concentrations <20 ng/ml (<50 nmol/l) and <10 ng/ml (<25 nmol/l) are considered to constitute vitamin D deficiency and severe deficiency, respectively. Observational data suggest an association between vitamin D deficiency and adverse health outcomes in postmenopausal women, although they cannot establish causality. The evidence from randomized controlled trials concerning vitamin D supplementation is not robust, since many studies did not consider whether people were deficient at baseline. Moreover, high heterogeneity exists in terms of the population studied, vitamin D dosage, calcium co-administration and duration of intervention. Concerning skeletal health, vitamin D deficiency is associated with low bone mass and an increased risk of fractures. Vitamin D supplementation at maintenance doses of 800-2000 IU/day (20-50 μg/day), after repletion of vitamin D status with higher weekly or daily doses, may be of benefit only when co-administered with calcium (1000-1200 mg/day), especially in the elderly populations and those with severe vitamin D deficiency. Concerning cardiovascular disease, vitamin D deficiency is associated with an increased prevalence of cardiovascular risk factors, mainly metabolic syndrome, type 2 diabetes mellitus and dyslipidemia. Vitamin D deficiency, especially its severe form, is associated with an increased risk of cardiovascular events (coronary heart disease, stroke, mortality), independently of traditional risk factors. Vitamin D supplementation may have a modestly beneficial effect on lipid profile and glucose homeostasis, especially in obese individuals or those ≥60 years old and at doses of ≥2000 IU/day (≥50 μg/day). However, it has no effect on the incidence of cardiovascular events. Concerning cancer, vitamin D deficiency is associated with increased incidence of and mortality from several types of cancer, such as colorectal, lung and breast cancer. However, the data on other types of gynecological cancer are inconsistent. Vitamin D supplementation has no effect on cancer incidence, although a modest reduction in cancer-related mortality has been observed. Concerning infections, vitamin D deficiency has been associated with acute respiratory tract infections, including coronavirus disease 2019 (COVID-19). Vitamin D supplementation may decrease the risk of acute respiratory tract infections and the severity of COVID-19 (not the risk of infection). Concerning menopausal symptomatology, vitamin D deficiency may have a negative impact on some aspects, such as sleep disturbances, depression, sexual function and joint pains. However, vitamin D supplementation has no effect on these, except for vulvovaginal atrophy, at relatively high doses, i.e., 40,000-60,000 IU/week (1000-1500 IU/week) orally or 1000 IU/day (25 μg/day) as a vaginal suppository.Copyright © 2022 Elsevier B.V. All rights reserved.